In vitro fertilization (IVF) is a method of treating infertility, during which the main stages of fertilization take place outside the woman's body, in the conditions of the embryological laboratory. After stimulation of the ovaries and puncture of the follicles, the embryologist works with the obtained eggs and seminal fluid, and further development of embryos takes place under laboratory control.
In the "Nadia Odesa" medical center, egg fertilization in IVF programs is mainly carried out by the method ICSI — intracytoplasmic sperm injection. During this procedure, the embryologist selects the sperm and injects it directly into the cytoplasm of the prepared egg. This makes it possible to control an important stage of fertilization and can be particularly appropriate in situations, when additional embryological assessment of biological material is required.
IVF may be used in some programs pre-implantation genetic testing of embryos — preimplantation genetic testing (PGT). It helps to assess the chromosomal status of the embryos and gives the doctor and embryologist additional data for the selection of the embryo before transfer. For patients, it means, that the decision to transfer can be based not only on the development and morphological characteristics of the embryo, but also on the results of genetic testing. At the same time, the result of the program depends on a combination of factors: age of the patient, diagnosis, quality of embryos, state of the endometrium and other medical features.
With the help of medicines, the growth of a group of follicles is stimulated, in which the eggs are maturing. Stimulation takes place under the supervision of a doctor: with the help of ultrasound and, if necessary, blood tests, the doctor monitors the development of follicles, the reaction of the ovaries and the patient's well-being. Appointments are adjusted if necessary, to support the optimal response of the body for a specific patient and not to create an unnecessary burden.
Puncture of follicles is the removal of follicular fluid with an aspiration needle with ultrasonic control and intravenous anesthesia. The procedure is performed under intravenous anesthesia, which helps minimize pain. On the day of the follicles puncture, a man hand over seminal fluid (or the embryologist defrost pre -cryo -free biological material). Eggs Embryologist gets from follicular fluid, and spermatozoa from seminal fluid.
The ICSI method consists in the introduction of a sperm suitable for motility and morphology into the cytoplasm of a mature egg, suitable for fertilization according to the embryologist's assessment. Checking egg fertilization occurs through 16-18 hours.
After fertilization, the embryos are placed in a special nutrient medium in an incubator, where conditions are maintained, close to physiological, in particular, the corresponding pH and temperature indicators. In general, the embryos stay in the incubator for up to 5–7 days.
To perform PGT, the embryologist biopsies several cells of the trophectoderm — a layer of cells, from which the placenta is later formed. The obtained material is transferred to a genetic study to assess the chromosomal status of the embryo.
For patients, it means, that before the transfer, the doctor and the embryologist take into account not only the development of the embryo, but also the rate of cell division, blastocyst formation and morphological characteristics, — and additional genetic data. This helps to choose an embryo for transfer not only based on external signs of development, and taking into account the results of chromosomal testing.
Vitrification is a method of quick and careful freezing of embryos, during which they are placed in a cryoprotectant and liquid nitrogen at a temperature of -196°C. This approach helps reduce the risk of ice crystals forming, which can damage cellular structures during freezing and thawing. Embryos can be stored in such conditions for a long time, including years. This gives patients more flexibility: transfers can be planned separately, after preparing the endometrium and assessing the body's readiness for this stage.
After preparation of the endometrium, the vitrified embryo is removed from liquid nitrogen and placed in a special environment to remove cryoprotectant residues. After thawing, the embryo is prepared for transfer into the uterine cavity. Transfer is performed using a thin catheter, usually does not require anesthesia and is easily tolerated by patients in most cases.
Through 2 weeks after the embryo transfer is performed a blood test for the hormone of HCG (Human chorionic gonadotropin) To confirm biochemical pregnancy. Through 4 weeks after transfer is ultrasound to confirm clinical pregnancy (Visualization of one or more fertile eggs).
For that, so that the first visit to the medical center is useful and meaningful for you, it is worth preparing and doing such research:
A complete list of necessary analyzes and conclusions of related specialists is provided by a reproductive specialist during a consultation after taking an anamnesis and familiarizing yourself with your medical history.
If you plan to start treatment for IVF program, Read the full list of research, which must be made before entering the extracorporeal fertilization program:
A complete list of research before entering the IVF program
Any visit to the doctor is stressful, and a visit to a reproductive specialist is no exception. We strongly advise you to prepare all the questions, who bother you, interest and frighten. The doctor will provide the necessary information about the stages, safety and possible risks of treatment.
When the treatment takes place in pairs, the participation of the partner at the first consultation helps the reproductive specialist to gather more complete information about the reproductive situation of both partners. It is also important for the couple themselves: when both partners hear the doctor's explanation, ask questions and understand possible treatment options, the decision on further steps becomes more balanced and joint.
If possible, Take all available medical certificates and documents with you. If the treatment takes place in pairs, it is desirable to prepare the documents of both partners. This will help the doctor to make a more detailed history, better assess the reproductive situation and take into account previous examinations when planning further steps. It is also worth remembering in advance, have you had pelvic surgery?, transferred infectious diseases, important chronic diseases, in particular, even in childhood.
The main indicator of the effectiveness of IVF programs is the percentage of clinical pregnancies — clinical pregnancy rate (CPR). It shows the ratio of embryo transfers, after which the pregnancy was confirmed by ultrasound, to the total number of transfers for a certain period.
According to internal data of the medical center "Nadia Odesa", CPR rate for the period of 2019 year before 01.06.2022 is 43.65%. This is a general statistical indicator, which helps to navigate the effectiveness of programs. For each patient, the prognosis is assessed individually, taking into account age, diagnosis, ovarian reserve, quality of embryos, endometrial condition and other medical factors.
For a general guideline, you can also use the published data of ESHRE - European Association of Human Reproduction and Embryology. According to these data, CPR indicators in different European countries are:
Germany — 26.5%
Greece — 43.4%
Spain — 34.9%
France — 22.9%
Belgium — 27.1%
Switzerland — 25.3%
Such data help to get a general idea of the effectiveness of the programs, but the most valuable thing for the patient is the individual prognosis, which the doctor forms after the consultation, examination and evaluation of the medical situation.
In vitro fertilization using the ICSI method Recommended for the treatment of male and female infertility, When such factors take place:
During the consultation, the reproductive specialist collects an anamnesis, evaluates the results of examinations and the medical situation of patients, and then provides a recommendation for the program. The final option is discussed and agreed with patients, taking into account medical indications, expectations and possibilities.
PGT It is recommended to carry out in such cases:
